老年髋关节置换围手术期心功能不全的处理

目的：探讨老年髋关节置换围手术期心功能不全的处理方法,以便更安全地进行手术。方法：回顾分析年龄在65岁以上并接受了髋关节置换的住院病人,按入院时心功能状态分为观察组及对照组,观察经过相应处理,两组病人重要心血管事件如死亡、急性心肌梗死、不稳定心绞痛等发生率是否不同。共109例病人被纳入分析。根据病人病情。两组病人分别给予了纠正高血压、糖尿病、贫血等并发症,控制肺感染,改善心肌缺血,治疗重要的心律失常,并予β受体阻断剂治疗及预防围手术期心血管并发症,血管紧张素转换酶抑制剂等药物改善病人心功能状态的治疗。结票：结果表明两组病人术中、术后重要心血管事件发生率未发现明显不同。结论：良好的围手术期处理,心功能不全患者接受髋关节置换术是安全的。     

全髋置换后康复干预时间与效果的比较

背景：观察全髋置换后康复干预开始时间对临床效果的影响。 方法：回顾性分析2000-07/2008-03湘南学院附属医院骨科收治的行全髋关节置换后康复治疗的患者165例,根据置换后行康复治疗时间的不同分为3组,早期康复组(n=56)：男27例,女29例;年龄44~79岁,置换前患髋Harris评分为(47.4±1.3)分,全髋置换后3 d行康复治疗。中期康复组(n=63)：男37例,女26例;年龄48~80岁,置换前Harris评分(45.6±2.1)分,全髋置换4~21 d后行康复治疗。延迟康复组(n=46)：男24例,女22例;年龄47~81岁,置换前Harris评分(46.3±1.5)分,全髋置换21 d后行康复治疗。3组按统一制定的康复训练计划实施功能锻练。于置换前,置换后1,2,3个月行Harris评分比较。 结果：行康复治疗的患者165例均进入结果分析。置换前3组髋关节Harris评分差异无显著性意义(P > 0.05);康复治疗后,置换后1个月Harris评分早期康复组平均(89.1±6.3)分,中期康复组平均(60.1±3.7)分,延迟康复组平均(54.6±3.5)分,早期康复组得分高于中期康复组及延迟康复组(P < 0.05)。置换后2个月Harris评分早期康复组平均(90.1±4.3)分,中期康复组平均(85.7±5.3)分,延迟康复组平均(69.8±3.8)分,早期康复组、中期康复组与延迟康复组之间相比,差异有显著性意义(P < 0.05)。置换后3个月Harris评分早期康复组平均(94.8±2.3)分,中期康复组平均(92.2±3.2)分,延迟康复组平均(90.5±3.1)分,3组之间相比,差异无显著性意义(P > 0.05)。 结论：早期系统康复治疗有利于全髋置换后髋关节功能的恢复。     

Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture

Introduction  The unstable atlas burst fracture (“Jefferson fracture”) is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The posterior atlantoaxial fusion is frequently used to reconstruct the stability of atlantoaxial joint. Conventional posterior atlantoaxial fixations are associated with high rates of pseudoarthrosis and chronic atlantoaxial instability. As a modified three-point fixation the bilateral C1-2 transarticular screws combined with C1 laminar hook and bone grafts can provide best biomechanical stability, but no standard protocol has been reported for the use of this fusion technique. A retrospective review of clinical series should be conducted to evaluate the clinical outcome of bilateral atlas laminar hook combined with transarticular screw fixation for unstable bursting atlantal fracture. Materials and methods  From March 2002 to March 2006, there were total 12 cases of unstable atlantal bursting fractures, 10 males and 2 females, age ranging 18–54, with mean of 36 years old. All patients were operated on posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation after atlantoaxial joint were reduced and followed up for 12–24 months. The medical records and radiographs of the 12 patients were reviewed. Each patient underwent a complete cervical radiograph series including lateral flexion-extension view and a computed topographic scan. The Frankel grades and ASIA scores were applied to assess the neurologic status. Results  In all patients, a good bony fusion of the atlanto-axial segment was achieved. All patients showed significant improvement of the neurologic defect and no instability on their follow-up plain radiographs and computerized tomography in follow-up interval. Conclusions  For the patients who suffer from the unstable bursting atlantal fracture, the nonoperative methods could carry some clinical complications including infection, nerve injury, etc. and is frequently failure, Posterior atlantoaxial fusion using bilateral atlas laminar hook combined with transarticular screw fixation is an effective treatment. Xiang Guo and Bin Ni contributed equally to the article.     

胫骨远端解剖钢板治疗不稳定性Pilon骨折的生物力学研究

目的：从生物力学角度探讨新型胫骨远端解剖铜板的力学性能。方法：将12具新鲜湿润成人踝关节标本,随机区组分为4组（每组3具）,3具正常胫骨作为对照（正常N组）,9具造成胫骨远端不稳定性Pilon骨折,分别采用新型胫骨远端解剖钢板固定（A组）、重建铜板固定（B组）、三叶草钢板固定（C组）,B、C两组为对照组,测试各组的远端轴向抗压强度、远端轴向刚度、扭转生物力学性能、胫距关节面接触特征。结果：A组在胫骨远端不稳定性Pilon骨折的远端轴向抗压强度、远端轴向刚度、扭转生物力学性能以及胫距关节面接触特征上接近正常N组（P〉0．05）,优于B、C组（P〈0．05）。结论：新型胫骨远端解剖钢板固定后比较牢固,能达到胫骨远端不稳定性Pilon骨折稳定、可靠的固定目的。     

Timely awareness and prevention of emerging chemical and biochemical risks in foods: Proposal for a strategy based on experience with recent cases

A number of recent food safety incidents have involved chemical substances, while various activities aim at the early identification of emerging chemical risks. This review considers recent cases of chemical and biochemical risks, as a basis for recommendations for awareness and prevention of similar risks at an early stage. These cases include examples of unapproved genetically modified food crops, intoxications with botanical products containing unintentionally admixed toxic herbs, residues of unapproved antibiotics and contaminants in farmed aquaculture species such as shrimp and salmon; and adverse effects of chemical and biological pesticides of natural origin. Besides case-specific recommendations for mitigation of future incidents of the same nature, general inferences and recommendations are made. It is recommended, for example, to establish databases for contaminants potentially present within products. Pro-active reconnaissance can facilitate the identification of products potentially contaminated with hazardous substances. In international trade, prevention and early identification of hazards are aided by management systems for product quality and safety, rigorous legislation, and inspections of consignments destined for export. Cooperation with the private sector and foreign authorities may be required to achieve these goals. While food and feed safety are viewed from the European perspective, the outcomes also apply to other regions.     

Safety assessment of diacylglycerol oil as an edible oil: A review of the published literature

Diacylglycerol oil is an edible oil with taste and usability characteristics comparable to naturally occurring oils. The objective of this review is to examine literature on diacylglycerol oil to assess its safety-in-use. Feeding rats with unheated or heated diacylglycerol oil at levels up to 5.5% in diet for 90 days did not cause any toxic effects. In chronic studies, dietary administration of diacylglycerol oil (up to 5.3%) to rats for 2 years or at 9.5% to Beagle dogs for 1 year had no adverse effects. Genotoxicity studies of unheated and heated diacylglycerol oil did not reveal any genotoxic effects. Carcinogenicity studies in rodents demonstrate that diacylglycerol oil is non-carcinogenic. In a two-generation reproductive and developmental toxicity study, gavage administration of diacylglycerol oil at dose levels of 5.0 ml/kg body weight/day did not reveal any adverse effects. In several human clinical investigations, administration of diacylglycerol oil at levels up to 0.5 g/kg body weight/day for up to 1 year did not cause adverse effects. Collectively, there is sufficient qualitative and quantitative scientific evidence available from animal and human studies suggesting that intake of diacylglycerol oil is safe for human consumption when used in a manner similar to other edible oils.     

细菌性阴道病3种检测方法的比较研究

目的 对比细菌性阴道病（BV）的3种检验方法,探求一种高效、便捷的临床诊断技术。方法367例疑似细菌性阴道病患者分别采用BV联合检测试剂盒、单项快速唾液酸酶测定法和Amsel标准进行Bv检测。结果BV联合检测法和单项快速唾液酸酶测定法两种方法学所测定数据分别与Amsel法测定数据进行统计学分析,经X^2检验,差异无统计学意义（P〉0．05）。结论细菌性阴道病联合检测法诊断细菌性阴道病（BV）灵敏度和特异性较高,具有检测速度快、操作简便、主观因素少等优点,值得临床推广应用。     

特制型人工假体在肱骨近端恶性肿瘤保肢治疗中的应用

目的肱骨近端恶性骨肿瘤的保肢治疗方法很多,但都面临同样的难题,即满足安全外科边界切除肿瘤的前提下尽量保留肢体功能,同时降低并发症的发生率.本研究探讨特制型人工假体置换在肱骨近段恶性骨肿瘤保肢治疗中的临床疗效.方法应用自行设计的定制型人工假体对2000年2月至2009年2月间的16例肱骨近端恶性肿瘤患者行保肢术.男性10例,女性6例.年龄14～56岁,平均（27±3）岁.病理证实：骨肉瘤10例,恶性纤维组织细胞瘤1例,尤文肉瘤1例,骨巨细胞瘤4例.骨巨细胞瘤按Campanicci分级：4例为Ⅲ级.其它12例患者以Enneking分期：Ⅱa期2例,Ⅱb期10例.除骨巨细胞瘤外均辅予术前、术后化疗.结果平均随访32个月（6～84个月）,置入假体无感染、松动及断裂等并发症.人工肩关节不完全脱位2例（12.5%,2/16）.术后肩关节功能按国际保肢学会（ISOLS）标准评分,优良率81.3%（13/16,评分≥24分）.结论应用特殊定制的人工假体置换能够降低术后并发症,获得较为满意的肩关节功能.     

单纯药物与联合康复性心理治疗对精神分裂症患者的影响

目的探讨单纯药物与联合康复性心理治疗对精神分裂症患者的影响。方法对我院2006年1月到2008年12月精神科门诊收治的128例精神分裂症患者进行单纯药物治疗和药物联合康复性心理治疗,应用简明精神症状评定量表（BPRS）、工作能力评定、社会功能缺陷筛选量表进行疗效评定,并随访（电话或家庭随访,1次／月）1—2年,所有评定工作均由接受过专科训练的医生或护士进行。结果能胜任一般工作状态者,观察组多于药物组,而观察组能监督但不能胜任工作状态和不能参加任何工作状态者较药物组为低,总体效果观察组优于药物组。观察组对患者的社会性退缩、婚姻职能、父母职能、生理自理较药物组的影响更大,治疗效果较好,观察组治疗后1年的复发率少于药物组。结论药物联合康复性心理治疗对精神分裂症患者治疗效果较好,值得临床推广。